Pulmonary Embolus

Question 1

Risk factors for PE?

Answer 1

• Age
• DVT, previous or FHx PE
• Recent surgery (2 months)
• Active malignancy
• Recent trauma/fracture
• Pregnancy/obesity/OCP/hormone replacement
• Nephrotic syndrome
• Thrombophilias
• LL paralysis
• Smoking
• Recent air travel
• Recent MI, active CCF

Question 2

Findings on history/exam in someone with PE?

Answer 2

• Risk factors
• Chest pain (pleuritic classic although may be aching)
• Dyspnoea
• Syncope/presyncope
• Cough/haemoptysis
• Anxiety
• Low grade fever

Question 3

Investigations appropriate in someone suspected of PE?

Answer 3

• ECG
• CXR
• ABG
• D-dimer
• CTPA, V/Q

Question 4

What are the management prinicples for someone with a known PE?

Answer 4

• Supportive care
  
  • High-flow oxygen, IV fluids
• Anticoagulation
  
  • LMWH preferred (e.g. enoxaparin)
  • Start warfarin and cease heparin when therapeutic
• Massive PE or haemodynamically unstable
  
  • Thrombolyse (alteplase)
  • Vasopressors
• PE despite anticoagulation?
  
  • Consider IVC filter placement

Question 5

On an ECG, what are the clasic findings for someone with a pulmonary embolus?

Answer 5

• RV strain (e.g. a new RBBB)
• S1Q3T3